Chat Log: Dr. Heather Einstein chats about cancer

Hello, I have a family history of breast and ovarian cancer. Should I be talking to my doctor about remvoing my ovaries (Im scheduled to have a hysterectomy).

5:21

Dr. Heather Einstein:

Thanks for your question. It is definitely important that your physician knows about your exact family history, and together you can determine if there is an indication to have your ovaries (and tubes--which is important) removed at the time of hysterectomy. It would probably be advisable to speak with a genetic counselor to determine your risk in order to help make that decision.

5:21

Comment From Guest

What are your thoughts on true prevention? Food? Limit the use of parebens?

5:23

Dr. Heather Einstein:

Thanks for your question. At this point there is a lot published on nutrition and other environmental factors, but we are unable to make specific causal links as much as we would like. My recommendation is always to eat healthy, exercise, and limit unnecessary toxins. In this situation we are talking about genetic predisposition to cancer, which is a little bit different. I would consider prophylactically removing tubes and ovaries, for instance, in a patient with a BRCA mutation, to be true prevention.

5:23

Comment From Guest

Who should be tested

5:28

Dr. Heather Einstein:

That is a great question. There are numerous published guidelines on this, unfortunately, they are a little too lengthy to type here. You can look at the NCCN guidelines for specifics (available on Google). However, in general, people with a personal history of any of the following: early breast cancer (<45 years old), multiple breast and/or ovarian cancers in one person, "triple negative" breast cancer, ovarian cancer, Ashkenazi Jewish decent, or a family history of multiple cancers, including male breast cancer, should speak to their doctor about being tested. Testing involves a lot of thought and counseling, so it is advisable to speak with someone who knows a lot about it (a medical oncologist, gynecologic oncologist, genetic counselor or a general ob/gyn with a special interest in hereditary cancers).

5:28

Comment From Barbra

Hi, my father died from prostate cancer and my mother had breast cancer twice. Should I be tested?

5:31

Dr. Heather Einstein:

Barbra, I am so sorry for your loss. I would definitely speak with your doctor. The best person to test is your mother. If she tests positive for one of the mutations of one of the BRCA genes, then you would need to be tested for that mutation. If she tests negative, it is less likely that you have a predisposition to hereditary cancer, but that would depend on the rest of your family history. The important thing to understand is that there are many different mutations of the BRCA 1 and 2 mutations, so it is best to test the person WITH the cancer first, to see which mutation they might have.

5:32

Comment From Guest

My mother died of breast cancer and her sister had it as did 2 of my first cousins on my mothers side. I had a hysterectomy but still have my ovaries.

5:35

Dr. Heather Einstein:

I am so sorry to hear about your mother. It sounds as though you would benefit from speaking with a medical oncologist, genetic counselor, or a gynecologic oncologist like myself. One of the important things to know is if anyone in your family with cancer ever got tested for the BRCA gene mutations. You are at risk for having a mutation (abnormality) in the BRCA gene based on your history, but I would need more information in order to counsel you specifically, which is why I would recommend making an appointment.

5:35

Comment From Ella

Hi Dr. Einstein. I just wanted to say that your interview was SO GOOD on Channel 3. You answered my questions.

5:35

Dr. Heather Einstein:

Thank you very much Ella, I appreciate your comment.

5:35

Comment From Kris

My grandmother and my aunt (my mother's mother and her sister) both passed away from breast cancer. I do have mammograms yearly. Would I be a candidate to have that blood test done?

5:37

Dr. Heather Einstein:

Kris, that is a great question. The best way situation is to test the person who had the cancer for the mutation. Breast cancer is relatively common in the general population, so it is possible to have the history you describe and not have a hereditary predisposition for cancer. It would be best for you to speak with your doctor, (or get referred to see a medical oncologist or genetic counselor) in order to assess your risk more specifically.

5:38

Comment From Sandy

Cancer runs in my family

5:38

Dr. Heather Einstein:

Sandy, I am sorry to hear about that. I would recommend you speak with your doctor about your family history and determine if you need additional surveillance or testing for cancer risk.

5:38

Comment From Guest

If your father and brother have had prostrate CA do the females in their family have an increased risk of breast cancer

5:40

Dr. Heather Einstein:

That is a difficult question as well. Prostate cancer alone, with no history of breast cancer in the family makes it unlikely that you have a BRCA gene mutation. However, it is always important to go over your family history in depth with your doctor.

5:41

Comment From Donna Levesque

My mother die from ancreatic cancer alost 2 years ago. Is ter a test I cn tak to check and se if I am going to get it too??

5:43

Dr. Heather Einstein:

Donna, I am so sorry to hear about your mother. There is not a specific test that tells you if you will have pancreatic cancer in the future. Even with these gene mutations, all we can say is that if you have an abnormal gene you have a higher risk of cancer, but not everyone who has a gene mutation will get cancer. Your risk really depends more on whether or not there are other cancers in the family--most cancers are not hereditary. I would speak with your doctor to be sure he/she is aware of your family history, and then can counsel you appropriately.

5:43

Comment From Grace

Hello there, Angelina Jolie appears to have done this over a course of several months. Is that how long it takes to have a mastectomy? What is involved?

5:45

Dr. Heather Einstein:

Grace, thanks for your question. I am not a breast surgeon (I take care of gynecologic cancer, like ovarian cancer, so I do the ovarian surgery). There are many options for mastectomy, some of which involve multiple surgeries over a period of time. If you think you are a candidate for that, I would recommend first speaking with a medical oncologist to find out if mastectomy is recommended, and then speak with a breast surgeon about your options.

5:45

Comment From Meg

Hi, I am being followed at Smilow for "precancerous" cervical cells...I am being followed every three - four months. We have not spoken about removing my ovaries...is this something we should be discussing? My grandmother had some type of uterine/ovarian cancer...although no one discussed it at that day and time and no one is here to answer questions...I'm 55. Your thoughts? Thanks

5:50

Dr. Heather Einstein:

Meg, that is a good question. Precancerous cells in the cervix are related to HPV, which is a virus, and therefore having them does NOT relate to the BRCA gene. Your situation is difficult because we do not know if you are at risk or not for a hereditary cancer based on what happened to your grandmother. If she is the only one if the family with cancer, I would be inclined to think not. However, I would definitely speak with your doctor at Smilow so he or she can find out more about your family history and determine if you need to see a genetic counselor or have more testing.

5:50

Comment From Guest

I am 42 years old. I have a strong family history of breast cancer. My doctor would like me to meet with a genetic counselor about testing for the gene. She mentioned having my mom go with me. My mom had breast cancer in each breast and one mastectomy. Would I be tested or my mother? Can you explain?

5:54

Dr. Heather Einstein:

Perfect question. Your doctor is right. The most important person to test is your Mom. There can be many, many different mutations to the BRCA genes. If your Mom tests positive for one of them, you (and your family members) can be tested for that gene. If your Mom tests negative, that means that you may have a hereditary cancer syndrome that we haven't discovered yet. In that case, you would need additional surveillance for breast and ovarian cancer, and you may need prophylactic surgery. It is obviously a complicated discussion, which is why I would recommend that you go to the genetic counseling visit with your mother.

5:55

Comment From Patty

My mother died from breast cancer and her sister has it and I also have 2 first cousins on her side that have it. I had a hysterectomy but still have my ovaries. What does the BRACA test involve how is it done?

5:56

Dr. Heather Einstein:

Patty, good question. The BRCA test is a blood test, just like any other blood test. The major thing is that it is important to get good counseling prior to the test, and good follow up afterwards. Deciding to get tested is a big decision that can impact you and your family, so it is important to understand what can happen, as well as how to interpret the results once you get them.

5:56

Comment From Sally

I am 55 years old and my mother died of ovarian cancer I had premature ovarian failure in my 30's. At that time, my OBGYN did not advise removal of my ovaries, saying that the procedure would not necessarily prevent cancer, and that other cells in my abdominal were from the same source as the ovaries, concluding that I could potentially get cancer anyway...whether I had my ovaries removed or not. What does research support now/

5:59

Dr. Heather Einstein:

Sally, I am sorry about the death of your Mom. Unfortunately, research hasn't caught up as much as we would like. For people in your situation, where the person who had the cancer is not alive and therefore cannot be tested, it involves a big discussion with your doctor about the pros and cons of BRCA testing and/or surgery. There is no right answer at this time, the only answer is the answer that is right for you once you have heard all the information on both sides. I would be happy to speak with you more about it in more depth if you make an appointment: Heather Einstein, Hartford Hospital, Division of Gynecologic Oncology 860-545-4341.

6:00

Comment From Gary

You mentioned this gene is indicative of pancreas cancer. If my father died from this cancer, should I be tested? I am a male.

6:01

Dr. Heather Einstein:

Gary, I am sorry to hear about your father. Most pancreatic cancers are sporadic (not hereditary). However, some can be associated with a BRCA 2 gene mutation. The decision to be tested would be influenced by what other cancers there are in your family. I would speak to your general physician about it as a starting place.

6:01

Comment From Jen

But with that gene, doesn't that gene need an outside influence (toxins) to activate it?

6:07

Dr. Heather Einstein:

Jen, good question. BRCA 1 and 2 are tumor suppressor genes. This means that the job of the gene is to prevent your cells from making mistakes that lead to cancer. Toxins can cause your cells to make mistakes in the DNA, and if your BRCA gene is not working, you may not be able to suppress those mistakes. So yes, in someways everything is related. We are just beginning to understand these relationships, and there are still many things that are unknown about why people get cancer.

6:07

Comment From Guest

My family has a breast cancer rate of nearly 100%. My sister was diagnosed at 42. It is not the BRCA-1 or 2 gene. My mother has had it twice. I wish, wish wish I could get someone interested in our form while there are still FOUR generations around that have had it, but no one seems to care because it is not BRCA. I am 48 and have not yet gotten it, so I think I may have escaped it. Is it possible for it to skip me and still hit my daughters?

6:14

Dr. Heather Einstein:

Thank you for your comments. That sounds like it must be very stressful, I am sorry. I am sure that my medical oncology colleagues and genetic counseling colleagues would be very happy to speak with you more and I promise they would take an interest! If you have a BRCA gene mutation in your family, (and I would need to know more about how it has been evaluated to comment on whether or not you do), it is inherited in an autosomal dominant fashion. That means you only need one copy of the abnormal gene to have the mutation. It also means that you cannot "skip" a generation so to speak. However,if you have a BRCA gene mutation, that means your risk of cancer is elevated--it does not guarantee you get cancer. So, you can have the gene mutation, not have cancer, pass the mutation on to your child, and he or she can get cancer. (Sorry to be so explicit--I know it sounds frightening when it is said that way). You can call my office, and I can help refer you to a medical oncologist. My information is: Heather Einstein, Hartford Hospital Division of Gynecologic Oncology 860-545-4341.

6:15

Comment From Wendy

A question about insurance and genetic testing,. I've been told that if you are tested and prove positive for some illness, you may have a hard time obtaining health insurance. Can you please discuss that and options?

6:17

Dr. Heather Einstein:

HI Wendy--there are laws to protect you (GINA) from being discriminated against due to a genetic predisposition to cancer. However, those laws do not cover life insurance, just health insurance. This is one of the major things that gets discussed when you meet with a genetic counselor. If you think you are at risk, I strongly recommend you speak to a physician and/or genetic counselor, and then make decisions about getting tested after you have all the facts. The reason why we advocated for people getting tested is that it can be life-saving to have prophylactic surgery, so you need to weigh the risks and benefits when thinking about getting tested.

6:18

Comment From Tori

You mentioned that there wasn't a test for ovarian cancer. Is there one?

6:20

Dr. Heather Einstein:

Tori, I may be confused about your question. I did mention that there is no effective SCREENING test for ovarian cancer. This means, in a person with no symptoms, there is not a test we can do to find an ovarian cancer at an early stage. In fact, even among women in whom we are looking for ovarian cancer, the majority of cancers are found at an advanced stage. However, there are tests we can do to find breast cancer. That is why we really emphasize, in women who have the BRCA gene mutation, that they should strongly consider having their tubes and ovaries out once they have completed child bearing.

6:21

Comment From Anita Kumar

for last 4 years my mammogram shows calcification which need me to go for diagnostic mammogram. My mother had breast cancer when she was 49 years old and she passed away at age 72. I am now 51 years old. Should I get BRAC1 and BRCA2 genetic test done. In 2009 I had biopsy done due to finding of calcification.

6:22

Dr. Heather Einstein:

Anita, thanks for your question. I am sorry about your mother. Based on that history alone, I would not recommend genetic testing, however, it is important to have a complete family history. I would recommend you discuss this with your doctor, and then make a decision together.

6:23

Comment From Sue B.

Every female in my family (grandmother, mother, aunt, sister) has had breast cancer. I've had several masses removed but so far remain cancer free. I''m 62 years old and now have issues with the ducts in my breast - should I consider having a mastectomy? I had a hysterectomy 12 years ago so my ovaries are gone. Thank you.

6:24

Dr. Heather Einstein:

Sue, thank you for your question. If any of the people in your family with a history of cancer are living, I would recommend that they be tested for the BRCA mutation. If not, I would recommend you speak with a medical oncologist. Feel free to call my office for a recommendation of a medical oncologist: Heather Einstein, Hartford Hospital Division of Gynecologic Oncology 860-545-4341.

6:25

Comment From Elizabeth

Hello can you please tell me if there are any concerns of Mirena IUD causing cancer? I am experiencing mood swings, weight gain and headaches almost every day and my medical Dr thought the Mirena may be the cause.Can you possibly give me some information. I had it inserted because of heavy periods and a possible issue with the lining of my uterus. I am 42 yrs old.I would appreciate any advice,thankyou.

6:26

Dr. Heather Einstein:

Hi Elizabeth-- actually, the Mirena IUD can decrease your risk of ovarian cancer and it can be used to treat precancer of the uterus. I am not aware of it increasing your risk for cancer.

6:26

Comment From Lyn

Who gets the BRACA tests done? I've never heard of this before so is it something I should be requesting or would my doctor make that decision?

6:27

Dr. Heather Einstein:

Lyn--Thank you for your question. There are published guidelines for whom should get tested. Your doctor will know about them. However, if you do not have a family history of cancer, this would not be a test that you should have done.

6:27

Comment From Brittany

Hi. Would this marker be cross-indicated in other types of cancer and is it seen in both maternal and paternal lines? While my maternal line is clear, I've had my paternal grandmother diagnosed at 75 with lung cancer and a paternal aunt with breast/lymp cancer at 45. As an example, what would this consult/procedure cost at HH? Thank you.

6:34

Dr. Heather Einstein:

Hi Brittany- Thank you for your questions. You can inherit a BRCA gene mutation from your mother or your father. I am not sure what the consult costs at HH, however, it should be covered by insurance. I would definitely call your insurance carrier to find out.

6:35

Comment From Nana

I've already had a double mastectomy and Hysterectomy, but Dr. told me they were unable to remove one ovary,embedded in intestines. Is this a cause for concern? Should I see another surgeon?

6:35

Dr. Heather Einstein:

Nana, if you have the BRCA gene mutation, I would recommend you have the other ovary removed. I would be happy to see you in my office. Heather Einstein, Hartford Hospital Division of Gynecologic Oncology 860-545-4341.

6:37

Comment From Lynn

Hello & thank you for taking the time to help! I am 33 years old and have been working with my doctors since I tested positive for BRCA1 mutation 4 years ago. My mother was diagnosed at 35 with estrogen negative breast cancer and my aunt was diagnosed at 33 and died at age 35 from breast cancer. Other relatives on the same side of my family also had breast cancer. I have become increasingly more concerned as I am approaching my mid 30s. My doctors said I have an 87 percent lifetime risk of developing breast cancer. When family members have cancer so young, does it mean that you are more likely to develop cancer young as well when you carry the BRCA1 gene mutation? I have been seriously considering prophylactic mastectomy for some time now but have taken my time to be as thorough as possible with research. Thank you,

6:40

Dr. Heather Einstein:

Lynn, the age at which your family members have cancer does affect when we would expect you would be at risk. In general, we recommend that people have prophylactic surgery 10 years before the youngest person in the family who had cancer. There is definitely a lot of discussion about whether a person like you should have mastectomy or should undergo surveillance. It sounds like you are already asking all the right questions. You have mentioned mastectomy, but not having your tubes and ovaries removed. I hope that you are discussing that with your physicians as well. Having your tubes and ovaries removed will decrease your risk of breast cancer by 50% and decrease your risk of ovarian/tubal cancer by over 90%.

6:45

Dr. Heather Einstein:

Thank you to everyone for all of your questions. I wish I had unlimited time to answer them all. Unfortunately, I am unable to. There were a few questions about insurance coverage--most insurance companies do cover genetic counseling and testing, though your should discuss that directly with your insurance carrier. This chat will be available on WFSB.com for you to review. --hopefully you will find some of your answers there. If you have further questions, I would recommend you speak with you doctor. If he or she thinks it is indicated, they can always refer you to my office. Thank you for your interest.

Technical Discussion

THE FINAL DAY OF SPRING… Some overnight cloud cover prevented temperatures this morning from going as cold as they could have, if the sky would’ve been clear. Now that they’re eroding, the rest of the day will be mostly sunny. After starting out in the 20s and low 30s, temperatures will peak in the upper 30s and lower 40s this afternoon – well below the average high of 49!

THE FINAL DAY OF SPRING… Some overnight cloud cover prevented temperatures this morning from going as cold as they could have, if the sky would’ve been clear. Now that they’re eroding, the rest of the day will be mostly sunny. After starting out in the 20s and low 30s, temperatures will peak in the upper 30s and lower 40s this afternoon – well below the average high of 49!

Technical Discussion

Monday will be bright and chilly. High temperatures will be in the mid to upper 30s in inland sections and lower 40s along the shore. A cell of high pressure will move overhead, and then to the east of the region today and will be the dominating factor in the weather, thus promising the quieter spell.

Monday will be bright and chilly. High temperatures will be in the mid to upper 30s in inland sections and lower 40s along the shore. A cell of high pressure will move overhead, and then to the east of the region today and will be the dominating factor in the weather, thus promising the quieter spell.